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Exploring depression
Exploring depression

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1.1 Understanding depression − key issues

The activities below will explore key issues to help you gain a broader understanding of depression.

Activity 2 Understanding depression: key issues

Timing: Allow approximately 1 hour

Listen to the podcast below and consider the questions that follow. You might wish to listen to the entire recording first and review this again thinking specifically about the questions the second time around. Alternatively, you can consider the questions as you listen to the recording the first time around. Choose whichever approach suits you best.

Download this audio clip.Audio player: BBC World Service ‘Discovery’ − Depression part 1
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BBC World Service ‘Discovery’ − Depression part 1
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In the first of two extracts on depression, broadcast in 2012 on the BBC’s ‘Discovery’ programme, Geoff Watts talks to researchers looking for clues to the origins of depression. In interviews with Professor Bill Deakin, Professor of Psychiatry at the University of Manchester, and Professor Randolph Nesse of the University of Michigan, he asks 'Why has natural selection not made us less vulnerable to psychological illness?', and questions whether depression can in some way be useful in our lives.

  1. What proportion of the population will suffer from diagnosable symptoms of depression at some point in their lifetime?

  2. Is depression on the increase in today’s society?

  3. Is depression an adaptive response? Can the capacity to become depressed be beneficial in some way?

  4. Explain the ‘smoke detector principle’ (a concept proposed by Randolph Nesse). How can this explain the increasing prevalence of depression?

Discussion

  1. About a fifth of the population, according to Professor Bill Deakin.
  2. It appears to be increasing in frequency, according to Professor Deakin – ‘the prevalence is increasing and the age of onset is getting less over succeeding decades’. Some of this may be due to more diagnoses being made, and a greater sensitivity to detecting symptoms when first presented to the family doctor (general practitioners). Professor Deakin explains that depression can be manifested in different ways and that some people who present with physical symptoms (e.g. aches and pains that won’t go away, and feeling generally unwell) may have depression as the underlying problem.
  3. Professor Randolph Nesse explains that many people assume that depression is abnormal, but the real question should be, why have we developed a 'capacity for mood'? ‘There are times in life when investing a lot and taking a lot of risks pays off handsomely’ and ‘there are other times in life, unfortunately, however, when the more effort you put in the more you’re wasting effort, and the more risks you’re taking’, and ‘there are somethings that we’re trying to do that just aren’t working’, so the more effort we put in the worse it gets. Dedicating energy towards a goal, and not making any progress can lead to depression. Geoff Watts comments that from an evolutionary perspective, natural selection has helped us to strive for goals to ensure that we survive, whereas ‘the goals in our lives today [are] shaped by our desires and the society we live in’ and these are equally powerful drivers of behaviour and emotion. The inability to fulfil these goals is, according to Randolph Nesse, what triggers low mood. Geoff Watts asks whether mild depression in itself could be a way of building some sort of resilience ‘to help mitigate future bouts of low mood’.
  4. Randolph Nesse views pain, nausea, fever, vomiting, anxiety and low mood as normal aversive, defensive responses, and that natural selection has shaped these responses to be greater than they really need to be. They are sensitive and similar to a smoke alarm in the sense that they can go off when they are not really needed (i.e. in the absence of imminent ‘real’ danger), but this is still a perfectly normal response, ‘because the system has to ensure that they go off in situations when they are needed’. So according to Nesse, we ‘put up with lots of false alarms on our smoke detectors because we want to be absolutely sure that it does go off when there is a fire’. Geoff Watts comments further that this is ‘an ancient biological system, far too sensitive for modern life especially in the culture which proclaims that "only losers quit", even when quitting may be beneficial’. Randolph Nesse’s hypothesis is that ‘low mood helps us to recognise when our ambitions are too lofty’. The experience of depression should therefore help us to reflect, reappraise our situation, learn from experience and adjust or reset our goals.

Listen to the podcast below and consider the questions that follow. You might wish to listen to the entire recording first and review this again thinking specifically about the questions the second time around. Alternatively, you can consider the questions as you listen to the recording the first time around. Choose whichever approach suits you best.

Download this audio clip.Audio player: BBC World Service ‘Discovery’ − Depression part 2
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BBC World Service ‘Discovery’ − Depression part 2
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In the second of the two extracts on depression broadcast in 2012 on the BBC’s ‘Discovery’ programme, Geoff Watts meets researchers studying the brain in people who have experienced traumatic life events, and explores the reasons why some people who experience such traumatic events are vulnerable to severe depression, while others are not. In this extract he talks with Professor Bill Deakin and Dr Rebecca Elliott from the University of Manchester, and Professor Randolph Nesse of the University of Michigan.

  1. How does Dr Elliott define ‘resilience’ in the context of mental health? Are most people resilient to some degree?

  2. What three general (hypothetical) aspects to resilience does Professor Deakin describe?

  3. Professor Deakin and researchers at Manchester were ‘working on the assumption that different states of mind, including vulnerability to depression, should correlate with different patterns of activity inside the brain’. What did they expect to find?

  4. Aaron, who is featured in the podcast and has volunteered to take part in the Manchester study, demonstrates some of the characteristics described for resilience. What are these?

  5. Dr Elliott talks about the involvement of the amygdala and the prefrontal cortex in resilience. Briefly explain how these brain regions are important in processing emotional information in people who are depressed.

  6. Is it possible to ‘promote’ resilience?

  7. How does Professor Deakin see ‘neuroscientific’ diagnoses operating in the future?

  8. Does Professor Nesse support this approach? Does he offer any alternative perspectives?

Discussion

  1. Dr Elliott defines resilience as ‘how well somebody is able to adapt and function in the face of stressful or traumatic experiences’. She explains that resilience can also be viewed along a ‘continuum’ in her view, with, at one end, people who may be vulnerable and ‘who in the face of quite low levels of stress or even potentially no stress at all will develop a mental health problem such as depression’. At the other end of the continuum there are those whom ‘life can deal an appalling hand, they can have all sorts of terrible stressful experiences, and yet remain positive and optimistic in the face of all that stress’. But most people are somewhere in the middle, ‘and we all potentially have a tipping point where enough stress, enough difficulties could cause us to have at least some degree of a problem’.
  2. Professor Deakin explains that (i) firstly some people may inherently be more sensitive to rewards in the environment (experiencing pleasurable events put us in a good mood), (ii) some people may be more flexible in how they solve problems (termed cognitive flexibility; i.e. more creative in how they get out of their difficulties), and (iii) some people may be more sensitive than others in how they respond to and process emotions, how emotional responses are triggered (the brain circuitry involved in controlling anxiety, our responses to threat and to loss). Geoff Watts notes that the characteristics of resilience could therefore be thought of in terms of neural circuitry, brain chemistry, previous experiences and genetic inheritance and their interaction.
  3. Dr Elliott explains that ‘at one end of the continuum, the ‘vulnerable’ people, we expect to show one pattern. The ‘resilient’ people at the other end another pattern’ and that both should differ from the ‘average pattern for people in the middle’.
  4. Aaron says that his life can get fairly stressful at times, but that it doesn’t affect him in the way that it perhaps affects others. He thinks that this may have something to do with his outlook on life. He tends to think that if there is a problem, a solution can always be found, so he can ‘think’ his way out of problems. Optimism as well as cognitive flexibility (in problem solving, for example) are aspects to resilience that have already been discussed.
  5. Dr Elliott explains that ‘in people who are currently experiencing depression, the amygdala is over-responding to negative information. So, if you see a picture of a sad face, and you’ve currently got depression your amygdala responds more strongly to that sad face’. She notes that the prefrontal cortex ‘is important in our cognitive performance, and to some extent in controlling our emotions’, and that ‘regions of the prefrontal cortex will tend to inhibit functions of regions like the amygdala’ and this is imbalanced in depression. She refers to early data suggesting that ‘people who are more resilient are more likely to recognise happy faces and less likely to recognise sad or fearful faces’, and that ‘the more resilient somebody is, the better they remember positive words and positive pictures’.
  6. Professor Deakin points to psychological therapies that are based around this concept. Once a person has had depression, the chances that they will have a further episode are substantially increased over that for the general population. Cognitive behavioural therapy, different psychological approaches and interpersonal psychotherapy are ‘a good way of reducing the chance of having a further episode’ if one has had depression.
  7. Professor Deakin sees these working more effectively as tailored to the individual. He explains this using the three aspects he referred to earlier as underlying resilience. For example, in one person, their depression could have been a consequence of ‘their reward mechanisms [being] fused’, whereas from the ‘emotional processing’ and ‘cognitive flexibility’ points of view they would be fine. In such an instance the therapy would be around promoting the ability to respond to reward.
  8. Professor Nesse is cautious of methods used to study resilience, but supportive of attempts to compare people who get depressed with those who do not. He notes the complexity of the underlying neurobiology, acknowledging that it turns out depression is not in one place or one neurotransmitter. It’s distributed in systems, and those systems aren’t there just to make us depressed because it’s a problem. They’re there because the capacity for mood is useful.’ He also points to the importance of considering people with depression ‘not just as people with diseases who are somehow less able, and less fit than others’, but as ‘people who have advantages as well as disadvantages’.

Before carrying on with the course, take 10 minutes to reflect on your learning so far.

  • Reflect on your learning in this section.

    • What were the key issues or concepts that stood out for you?

    • Can you offer further or alternative perspectives, drawing on your own personal or professional experience?

We will look more closely at diagnosis and explore depression further in Section 2.